Ecological Praxis and Blackwater Ecosystems: A Case Study From the Brazilian Amazon

This article explores how anthropogenic modifications of soil condition human adaptive processes on the Amazonian uplands. The occurrence of black earth (a nutrient-rich anthrosol) in nutrient-poor blackwater environments and its cultivation by contemporary residents provide a unique opportunity for understanding the ecological praxis of Amazonian groups. Two years of ethnographic, ethnoscientific, and agronomic research among caboclo residents of the Lower Rio Negro and Rio Urubú confirm that unique cognitive and behavioral orientations characterize black earth and adjacent environments. When compared with cognitive and behavioral orientations to these two environments in distant blackwater regions, data suggest that political-economic, technological, cultural, and ecological factors have had~a strong influence on the trajectory of human-environmental interactions. Data in large part illustrate the utility of historical ecological models, yet point to an interactive role of diverse histories in shaping the range of human responses.     

Conservation Efforts May Increase Malaria Burden in the Brazilian Amazon

Background

Large-scale forest conservation projects are underway in the Brazilian Amazon but little is known regarding their public health impact. Current literature emphasizes how land clearing increases malaria incidence, leading to the conclusion that forest conservation decreases malaria burden. Yet, there is also evidence that proximity to forest fringes increases malaria incidence, which implies the opposite relationship between forest conservation and malaria. We compare the effect of these environmental factors on malaria and explore its implications.

Methods and Findings

Using a large malaria dataset (∼1,300,000 positive malaria tests collected over ∼4.5 million km²), satellite imagery, permutation tests, and hierarchical Bayesian regressions, we show that greater forest cover (as a proxy for proximity to forest fringes) tends to be associated with higher malaria incidence, and that forest cover effect was 25 times greater than the land clearing effect, the often cited culprit of malaria in the region. These findings have important implications for land use/land cover (LULC) policies in the region. We find that cities close to protected areas (PA’s) tend to have higher malaria incidence than cities far from PA’s. Using future LULC scenarios, we show that avoiding 10% of deforestation through better governance might result in an average 2-fold increase in malaria incidence by 2050 in urban health posts.

Conclusions

Our results suggest that cost analysis of reduced carbon emissions from conservation efforts in the region should account for increased malaria morbidity, and that conservation initiatives should consider adopting malaria mitigation strategies. Coordinated actions from disparate science fields, government ministries, and global initiatives (e.g., Reduced Emissions from Deforestation and Degradation; Millenium Development Goals; Roll Back Malaria; and Global Fund to Fight AIDS, Tuberculosis and Malaria), will be required to decrease malaria toll in the region while preserving these important ecosystems.     

P. vivax Malaria and Dengue Fever Co-infection: A Cross-Sectional Study in the Brazilian Amazon

Background

Malaria and dengue are the most prevalent vector-borne diseases worldwide and represent major public health problems. Both are endemic in tropical regions, propitiating co-infection. Only few co-infection cases have been reported around the world, with insufficient data so far to enhance the understanding of the effects of co-infection in the clinical presentation and severity.

Methodology/Principal Findings

A cross-sectional study was conducted (2009 to 2011) in hospitalized patients with acute febrile syndrome in the Brazilian Amazon. All patients were submitted to thick blood smear and PCR for Plasmodium sp. detection, ELISA, PCR and NS1 tests for dengue, viral hepatitis, HIV and leptospirosis. In total, 1,578 patients were recruited. Among them, 176 (11.1%) presented P. vivax malaria mono-infection, 584 (37%) dengue fever mono-infection, and 44 (2.8%) were co-infected. Co-infected patients had a higher chance of presenting severe disease (vs. dengue mono-infected), deep bleeding (vs. P. vivax mono-infected), hepatomegaly, and jaundice (vs. dengue mono-infected).

Conclusions/Significance

In endemic areas for dengue and malaria, jaundice (in dengue patients) and spontaneous bleeding (in malaria patients) should raise the suspicion of co-infection. Besides, whenever co-infection is confirmed, we recommend careful monitoring for bleeding and hepatic complications, which may result in a higher chance of severity, despite of the fact that no increased fatality rate was seen in this group.     

Population and Land Use Effects on Malaria Prevalence in the Southern Brazilian Amazon

Malaria prevalence has been one of the most dramatic outcomes of the occupation of the Brazilian Amazon as exemplified by Northern Mato Grosso, one of the areas of highest malaria prevalence in the Americas in the early 1990s. This paper associates the dynamicsof high malaria prevalence in Northern Mato Grosso with three land uses—small-scalegold mining (garimpos), agricultural colonization/cattle ranching (rural), and urban activities—and their related population characteristics, which constitute riskprofiles. Furthermore, spatial proximity and population mobility between (a) garimpos and new rural settlements and (b) older rural settlements or urban areas are key factors explaining malaria diffusion throughout the region. The paper identifies and characterizes populations at high malaria risk and the effects of land use types on malaria diffusion, providing policymakers with information for regional and local policies to control malaria and minimize its effects on Amazonian populations.     

Surveillance of Avian Influenza Virus in Aquatic Birds on the Brazilian Amazon Coast

EcoHealth - The occurrence of avian influenza viruses (AIV) has been extensively studied in aquatic birds in the Northern hemisphere; however, much less information is available for the South...     

Influence of Deforestation,Logging, and Fire on Malaria in the Brazilian Amazon

Malaria is a significant public health threat in the Brazilian Amazon. Previous research has shown that deforestation creates breeding sites for the main malaria vector in Brazil, Anopheles darlingi, but the influence of selective logging, forest fires, and road construction on malaria risk has not been assessed. To understand these impacts, we constructed a negative binomial model of malaria counts at the municipality level controlling for human population and social and environmental risk factors. Both paved and unpaved roadways and fire zones in a municipality increased malaria risk. Within the timber production states where 90% of deforestation has occurred, compared with areas without selective logging, municipalities where 0–7% of the remaining forests were selectively logged had the highest malaria risk (1.72, 95% CI 1.18–2.51), and areas with higher rates of selective logging had the lowest risk (0.39, 95% CI 0.23–0.67). We show that roads, forest fires, and selective logging are previously unrecognized risk factors for malaria in the Brazilian Amazon and highlight the need for regulation and monitoring of sub-canopy forest disturbance.     

Micronutrient Deficiencies and Plasmodium vivax Malaria among Children in the Brazilian Amazon

Background

There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria incidence and vice versa in the Brazilian state of Amazonas.

Methodology/Principal Findings

We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3–6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels.

Conclusion

Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results.     

Insects as Food: A Case Study from the Northwest Amazon

In this article I examine the use of insects as food by Tukanoan Indians in the Northwest Amazon and discuss both the characteristics of the species exploited and their significance in the diet. Data on insect collection were obtained from harvest records and participant-observation. Dietary intake was determined from weighed food intake records. The insects collected belonged to over 20 species. The most important in the diet were those which formed large, highly predictable aggregations: beetle larvae (genus Rhynchophorus), ants (genus Atta), termites (genus Syntermes), and caterpillars (families Noctuidae and Saturniidae). The composition of insects is similar to that of other animal foods. Their inclusion in the diet was frequent and inversely related to the consumption of fish and game. They provided up to 12% of the crude protein derived from animal foods in men's diets and 26% in women's diets during one season of the year.     

Impacts of Cash Transfer Programs on Rural Livelihoods: a Case Study in the Brazilian Amazon Estuary

We conducted a large household survey in a region of the Amazon estuary in Brazil to investigate the dependence of small farming households on government cash transfers and to identify the main factors that lead to better livelihood outcomes. The study examined the factors that contribute to heterogeneous household livelihoods and patterns of dependence on cash transfer programs. Multinomial logistic regression was used to evaluate household attributes affecting the level of dependence on cash transfers. Results indicate that households engage in a diversity of livelihood strategies, and vary in dependence on cash transfers. Lower levels of dependency are associated with higher levels of education and income from off-farm activities as well as larger property sizes and holdings in the várzea. Recognition of the causes and potential range of dependence on cash transfer programs adds decision-making capacity for policy makers seeking avenues to reduce dependence and increase program effectiveness.     

Severity of Scorpion Stings in the Western Brazilian Amazon: A Case-Control Study

Background

Scorpion stings are a major public health problem in Brazil, with an increasing number of registered cases every year. Affecting mostly vulnerable populations, the phenomenon is not well described and is considered a neglected disease. In Brazil, the use of anti-venom formulations is provided free of charge. The associate scorpion sting case is subject to compulsory reporting. This paper describes the epidemiology and identifies factors associated with severity of scorpions stings in the state of Amazonas, in the Western Brazilian Amazon.

Methodology/Principal Findings

This study included all cases of scorpion stings in the state of Amazonas reported to the Brazilian Diseases Surveillance System from January 1, 2007 to December 31, 2014. A case-control study was conducted to identify factors associated with scorpions sting severity. A total of 2,120 cases were reported during this period. The mean incidence rate in the Amazonas was 7.6 per 100,000 inhabitants/year. Scorpion stings showed a large spatial distribution in the state and represent a potential occupational health problem for rural populations. There was a positive correlation between the absolute number of cases and the altimetric river levels in the Central (p<0.001; R_s = 0.479 linear) and Southwest (p = 0.032; linear R_s = 0.261) regions of the state. Cases were mostly classified as mild (68.6%), followed by moderate (26.8%), and severe (4.6%). The overall lethality rate was 0.3%. Lethality rate among children ≤10 years was 1.3%. Age <10 years [OR = 2.58 (95%CI = 1.47–4.55; p = 0.001)], stings occurring in the rural area [OR = 1.97 (95%CI = 1.18–3.29; p = 0.033) and in the South region of the state [OR = 1.85 (95%CI = 1.17–2.93; p = 0.008)] were independently associated with the risk of developing severity.

Conclusions/Significance

Scorpion stings show an extensive distribution in the Western Brazilian Amazon threatening especially rural populations, children ≤10 in particular. Thus, the mapping of scorpions fauna in different Amazon localities is essential and must be accompanied by the characterization of the main biological activities of the venoms. Urban and farming planning, in parallel with awareness of workers at risk for scorpion stings on the need for personal protective equipment use should be considered as public policies for preventing scorpionism.     

Generation of Domestic Solid Waste in Rural Areas: Case Study of Remote Communities in the Brazilian Amazon

The Brazilian rural population is estimated to be around 30 million people and many rural areas do not have universal access to basic infrastructure services, including those related to solid waste. There are very few scientific studies on rural domestic solid waste and more investigative work is needed to provide information for appropriate solid waste management policies. This paper aims to characterize rural domestic solid waste in terms of quantity and quality. Amazonian rural communities were chosen for our case study. The issue of domestic solid waste was characterized both by means of interviews, at household level, and by a study of industrialized products traded in the communities located along the banks of the Juruá River, in the Brazilian Amazon. Quantitative results have shown that generation of solid waste in these rural communities reaches 0.5 kg/person/day. Organic matter represents 90 % of domestic solid waste generation and is mainly reused to feed animals and/or is composted using a method called paú. Inorganic solid waste (10 %) is either reused, burned or inadequately dumped in open sites. Based on these data, the annual production of solid waste is 437 tons per year in these communities. Since infrastructure services are virtually non-existent in this rural context, even this amount of solid waste may have a serious environmental impact, with negative effects on the population’s health, particularly in terms of hazardous waste. Even though solid waste management solutions for rural populations might not always be based on economic efficiency, decision makers responsible for development and planning should present solutions that are socially, technologically, environmentally and economically suitable for this context.     

Mixing Carrots and Sticks to Conserve Forests in the Brazilian Amazon: A Spatial Probabilistic Modeling Approach

Annual forest loss in the Brazilian Amazon had in 2012 declined to less than 5,000 sqkm, from over 27,000 in 2004. Mounting empirical evidence suggests that changes in Brazilian law enforcement strategy and the related governance system may account for a large share of the overall success in curbing deforestation rates. At the same time, Brazil is experimenting with alternative approaches to compensate farmers for conservation actions through economic incentives, such as payments for environmental services, at various administrative levels. We develop a spatially explicit simulation model for deforestation decisions in response to policy incentives and disincentives. The model builds on elements of optimal enforcement theory and introduces the notion of imperfect payment contract enforcement in the context of avoided deforestation. We implement the simulations using official deforestation statistics and data collected from field-based forest law enforcement operations in the Amazon region. We show that a large-scale integration of payments with the existing regulatory enforcement strategy involves a tradeoff between the cost-effectiveness of forest conservation and landholder incomes. Introducing payments as a complementary policy measure increases policy implementation cost, reduces income losses for those hit hardest by law enforcement, and can provide additional income to some land users. The magnitude of the tradeoff varies in space, depending on deforestation patterns, conservation opportunity and enforcement costs. Enforcement effectiveness becomes a key determinant of efficiency in the overall policy mix.     

Major Burden of Severe Anemia from Non-Falciparum Malaria Species in Southern Papua: A Hospital-Based Surveillance Study

Background

The burden of anemia attributable to non-falciparum malarias in regions with Plasmodium co-endemicity is poorly documented. We compared the hematological profile of patients with and without malaria in southern Papua, Indonesia.

Methods and Findings

Clinical and laboratory data were linked for all patients presenting to a referral hospital between April 2004 and December 2012. Data were available on patient demographics, malaria diagnosis, hemoglobin concentration, and clinical outcome, but other potential causes of anemia could not be identified reliably. Of 922,120 patient episodes (837,989 as outpatients and 84,131 as inpatients), a total of 219,845 (23.8%) were associated with a hemoglobin measurement, of whom 67,696 (30.8%) had malaria. Patients with P. malariae infection had the lowest hemoglobin concentration (n = 1,608, mean = 8.93 [95% CI 8.81–9.06]), followed by those with mixed species infections (n = 8,645, mean = 9.22 [95% CI 9.16–9.28]), P. falciparum (n = 37,554, mean = 9.47 [95% CI 9.44–9.50]), and P. vivax (n = 19,858, mean = 9.53 [95% CI 9.49–9.57]); p-value for all comparisons <0.001. Severe anemia (hemoglobin <5 g/dl) was present in 8,151 (3.7%) patients. Compared to patients without malaria, those with mixed Plasmodium infection were at greatest risk of severe anemia (adjusted odds ratio [AOR] 3.25 [95% CI 2.99–3.54]); AORs for severe anaemia associated with P. falciparum, P. vivax, and P. malariae were 2.11 (95% CI 2.00–2.23), 1.87 (95% CI 1.74–2.01), and 2.18 (95% CI 1.76–2.67), respectively, p<0.001. Overall, 12.2% (95% CI 11.2%–13.3%) of severe anemia was attributable to non-falciparum infections compared with 15.1% (95% CI 13.9%–16.3%) for P. falciparum monoinfections. Patients with severe anemia had an increased risk of death (AOR = 5.80 [95% CI 5.17–6.50]; p<0.001). Not all patients had a hemoglobin measurement, thus limitations of the study include the potential for selection bias, and possible residual confounding in multivariable analyses.

Conclusions

In Papua P. vivax is the dominant cause of severe anemia in early infancy, mixed P. vivax/P. falciparum infections are associated with a greater hematological impairment than either species alone, and in adulthood P. malariae, although rare, is associated with the lowest hemoglobin concentration. These findings highlight the public health importance of integrated genus-wide malaria control strategies in areas of Plasmodium co-endemicity. Please see later in the article for the Editors'' Summary     

Shifting Cultivation and Fire Policy: Insights from the Brazilian Amazon

Fires in humid tropical forests are increasingly frequent due to severe dry seasons, forest degradation and agricultural expansion. One agent implicated in current discourse surrounding tropical forest fires is the small-scale farming peasantry who rely on fire in swidden (shifting cultivation, slash-and-burn) agriculture. The environmental degradation associated with fire has led to government responses at multiple scales (international, national, state, regional) via policies aimed mainly at managing ignition sources. However, continued increase in forest fires suggests that these policies may be having limited impact and a fresh evaluation of current policy approaches to fire management is needed. We review fire policy measures with insights of caboclo farming practices and perspectives from Eastern Amazonia and examine the congruence between policy and practice. We demonstrate a significant disparity between policy requirements such as firebreaks and actual fire management practices, in which measures rarely meet requirements outlined in legislation. We explore the origins and the impacts of these disparities, focussing on smallholder farm-level management measures and local capacity. Incomplete knowledge coupled with marginal awareness of legal requirements served to propagate widespread erroneous beliefs in what these are. This analysis at multiple scales (international, national, state, regional) will contribute to developing greater congruence between fire policies and smallholder farming practices.     

Plasmodium vivax Malaria in Pregnant Women in the Brazilian Amazon and the Risk Factors Associated with Prematurity and Low Birth Weight: A Descriptive Study

Introduction

Plasmodium vivax is the most prevalent malaria species in the American region. Brazil accounts for the higher number of the malaria cases reported in pregnant women in the Americas. This study aims to describe the characteristics of pregnant women with malaria in an endemic area of the Brazilian Amazon and the risk factors associated with prematurity and low birth weight (LBW).

Methods/Principal Findings

Between December 2005 and March 2008, 503 pregnant women with malaria that attended a tertiary health centre were enrolled and followed up until delivery and reported a total of 1016 malaria episodes. More than half of study women (54%) were between 20–29 years old, and almost a third were adolescents. The prevalence of anaemia at enrolment was 59%. Most women (286/503) reported more than one malaria episode and most malaria episodes (84.5%, 846/1001) were due to P. vivax infection. Among women with only P. vivax malaria, the risk of preterm birth and low birth weight decreased in multigravidae (OR, 0.36 [95% CI, 0.16–0.82]; p = 0.015 and OR 0.24 [95% CI, 0.10–0.58]; p = 0.001, respectively). The risk of preterm birth decreased with higher maternal age (OR 0.43 [95% CI, 0.19–0.95]; p = 0.037) and among those women who reported higher antenatal care (ANC) attendance (OR, 0.32 [95% CI, 0.15–0.70]; p = 0.005).

Conclusion

This study shows that P. vivax is the prevailing species among pregnant women with malaria in the region and shows that vivax clinical malaria may represent harmful consequences for the health of the mother and their offsprings particularly on specific groups such as adolescents, primigravidae and those women with lower ANC attendance.     

Estimating Influenza Disease Burden from Population-Based Surveillance Data in the United States

Annual estimates of the influenza disease burden provide information to evaluate programs and allocate resources. We used a multiplier method with routine population-based surveillance data on influenza hospitalization in the United States to correct for under-reporting and estimate the burden of influenza for seasons after the 2009 pandemic. Five sites of the Influenza Hospitalization Surveillance Network (FluSurv-NET) collected data on the frequency and sensitivity of influenza testing during two seasons to estimate under-detection. Population-based rates of influenza-associated hospitalization and Intensive Care Unit admission from 2010–2013 were extrapolated to the U.S. population from FluSurv-NET and corrected for under-detection. Influenza deaths were calculated using a ratio of deaths to hospitalizations. We estimated that influenza-related hospitalizations were under-detected during 2010-11 by a factor of 2.1 (95%CI 1.7–2.9) for age < 18 years, 3.1 (2.4–4.5) for ages 18-64 years, and 5.2 (95%CI 3.8–8.3) for age 65+. Results were similar in 2011-12. Extrapolated estimates for 3 seasons from 2010–2013 included: 114,192–624,435 hospitalizations, 18,491–95,390 ICU admissions, and 4,915–27,174 deaths per year; 54–70% of hospitalizations and 71–85% of deaths occurred among adults aged 65+. Influenza causes a substantial disease burden in the U.S. that varies by age and season. Periodic estimation of multipliers across multiple sites and age groups improves our understanding of influenza detection in sentinel surveillance systems. Adjusting surveillance data using a multiplier method is a relatively simple means to estimate the impact of influenza and the subsequent value of interventions to prevent influenza.     

Poverty and Inequality in the Rural Brazilian Amazon: A Multidimensional Approach

This paper analyses poverty and inequality dynamics among smallholders along the Transamazon Highway. We measure changes in poverty and inequality for original settlers and new owners, contrasting income-based with multidimensional indices of well-being. Our results show an overall reduction in both poverty and inequality among smallholders, although poverty decline was more pronounced among new owners, while inequality reduction was larger among original settlers. This trend suggests that families have an initial improvement in livelihood and well-being which tends to reach a limit later—a sign of structural limitations common to rural areas and maybe a replication of boom and bust trends in local economies among Amazonian municipalities. In addition, our multidimensional estimates of well-being reveal that some economically viable land use strategies of smallholders (e.g., pasture) may have important ecological implications for the regional landscape. These findings highlight the public policy challenges for fostering sustainable development among rural populations.